Behind the Rituals

Fewer than two registered nurses present on a ward during any shift, day or night, represents a patient safety “red-flag”, according to major guidelines for the NHS.

In addition, nurse managers must check staffing levels are safe on hospital wards where each registered nurse is caring for more than eight patients during day shifts.

The guidelines state that nurses in charge of shifts should monitor for the occurrence of “nursing red-flag events” during each 24-hour period. Where one occurs, it should “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.

Let’s discuss…

Is an “immediate escalation response” realistic for every red-flag event?

NICE’s new draft guidance suggests people with a BMI score of 30 to 35 should be considered for an assessment for weight-loss operations if they have been diagnosed with diabetes within the last 10 years.

This could mean hundreds of thousands more patients could be considered for treatment.

What do you think of this story?

Should more patients with diabetes be offered weight loss surgery?

Is there a risk that this option may be seen as a “quick fix”?

With 10% of the NHS budget currently spent on diabetes, could this save the NHS money in the long run?

Staff at Worthing Hospital in Sussex “pulled out all the stops” to ensure a couple’s wedding went ahead on their planned day, despite the bride having to stay in hospital for care.

Joann Howells, 46, from East Preston, who was receiving cancer treatment revealed to a nurse how disappointed she was to have to cancel her wedding planned for 21 June.

Hospital staff worked together to give the couple a wedding ceremony and reception.

It’s not always possible to do what Ms Howells’ nurses did and opportunities don’t always present themselves, but when you’re been able to, how have you gone the extra mile for your patients?

Share your stories in the comments section below. The most inspiring will win a copy of ‘Mastering Mentorship’ by Julie Bailey-McHale and Donna Hart, published by SAGE.

Please note that although we appreciate you may wish to remain anonymous, we cannot offer the prize to commenters we can’t identify.

‘This book is an important contribution to the literature of applying mentorship to practice, it is a well written, no nonsense guide and will be an invaluable resource for mentors and mentees’ – Bev Critchlow, Chief Nurse, Isle of Man

I was at Nottingham University Hospital Research conference last week and listened to an interesting paper about washing sedated patients on intensive care units at night (between 9pm and 11pm). The aim is to reduce the interruptions that occur when someone is being washed during the day. The team are in the process of evaluating the change.

Let’s discuss…

Are we still tied to routine and rituals around washing patients in the morning?

A recent news story in Nursing Times highlighted the views of the ethicist Dr Anthony Wrigley who suggested that axing the Liverpool Care Pathway (LCP) was “too extreme”. He said scrapping the measure on the basis of some poor use was like prohibiting the use of morphine.

It is generally accepted that there were problems with its implementation, but what will fill the gap when the pathway is phased out?

What do you think?

Does your organisation have plans to replace it?

Have you had training and education to manage palliative care without the LCP?

Central and North West London Foundation Trust tests nursing applicants for numeracy and literacy, and regularly sees failure rates of 50-80%.

Health Education England has now appealed for evidence of the “anecdotal” problem amid greater focus on the education and training of qualified nurses following the Francis Report into care failings at Mid Staffordshire Foundation Trust.

On individual wards, the draft guideline highlights the importance of the nursing team’s awareness of patient needs and “red flag events”, which signal that an immediate response is needed, such as an urgent need for additional nurses.

What do you think of this announcement?

Should NICE have gone further and formally recommended a minimum staffing level?

Are there enough nurses working in the UK to fulfil a one nurse to eight patients ratio?

Could trusts use this guidance as an excuse to not bring in additional nurses when needed if they are already below 1:8?

Why do you do the things you do? How much of nursing practice is based on ritual and myth and how much on sound evidence? If you have a ritual you’d like to discuss here, email nursingtimescomments@emap.com